This is not an example of the work produced by our Dissertation Writing Service. The IHCD Paramedic programme had a major focus on the management of trauma, resuscitation and life threatening emergencies, with limited provision for psychosocial, mental health or behavioural presentations (IHCD 2003). There are two broad ‘models’ for Emergency Medical System (EMS) staffing in different parts of the world: the Anglo-American model and the Franco-German model. On arriving at the emergency scene, paramedics would assess the condition of the patient and quickly work out a decision geared towards saving the life of the patient. Other employers include: 1. the armed forces 2. Paramedics are not taught how to conduct a psychosocial assessment within their training and education, but nevertheless may increasingly using such risk assessment tools advocated by JRCALC which are commonly used in ED. The College represents its members in all matters affecting their clinical practice and supports them to achieve the highest standards of patient care. The role of the paramedic is to provide excellent and quality pre-hospital care to patients across the region. Education, skills, competence and even the availability of pharmacological agents which may be used to restrain individuals following SH are some examples of potential differences in physician versus non-physician models of EMS provision. However, when considering the significant influence of policies such as NSF CHD (2000) over the evolution in the role and education of paramedics, greater recognition in mental health policy of the impact on ambulance services, and the potential contribution their staff could make to the provision of mental health care, may have resulted in better opportunities to influence education and the development of the paramedic role at a time of significant transition and development? cycle response), as well as emergency response vehicles. However, it has long been recognised that much of what is currently believed about pre hospital and paramedic care is based on custom and tradition rather than sound scientific evidence (Lemonick 2009), and Callaham (1997 p231) described the situation as: “The scanty science of pre hospital care” (p.231). The many definitions of self-harming behaviour were explored, and whilst the RCPsych (2010) definition is presented in this thesis, the challenges and limitations of such definitions are recognised. The Code advises that those privy to the local policy should meet regularly to discuss its effectiveness in the light of experience, and review the policy where necessary, to decide when information about specific cases can be shared for the purpose of protecting the person or others, in line with the law. Paramedics can examine, evaluate and treat patients with equipment and medications usually only found in the emergency department of a hospital. An example of such pieces of equipment are the defibrillators, used in restoring the heart’s rhythm. East of England Ambulance Service Trust: Patient Survey Results, Aintree Hospital Trauma Centre: HELP Helipad Launch. These recommendations call for Ambulance staff to be trained in the assessment and early management of SH, and how, if following SH, the service user does not require emergency treatment in the ED, ambulance staff should consider, taking the service user to an alternative appropriate service, such as a specialist mental health service, and that the decision to do so should be taken jointly between ambulance staff, the service user and the receiving service. The nature of a paramedic’s role requires the provision of advance levels of care in times of medical emergencies and traumatic situations. The Mental Health Code of Practice (2015) provides statutory guidance to registered medical practitioners, approved clinicians, managers, providers of care, other staff and approved mental health professionals on how they should carry out functions under this Act in practice. Suicides statistics can give a misleading picture of the prevalence of suicide when considered alone, as rates per 100,000 people are often reported which take into account the effect of population size on the number of suicides (Samaritans 2012). This group is made up of the police, the Lincolnshire Partnership Foundation Trust (LPFT), the ambulance service, Approved Mental Health Professionals (AMHPs) and the Local Authority. Other than these excluded areas, the police will be able to exercise their powers under section 136 anywhere which will facilitate the Police to act quickly to protect people found in places such as railway lines, offices and rooftops which have previously not necessarily been considered as places to which the public have access. JRCALC gather the available evidence in areas of ambulance service and paramedic care, which is discussed by a team of academics, clinicians and ambulance service representatives. In the UK, the Joint Royal Colleges Ambulance Liaison Committee Paramedic Guidelines (JRCALC 2006) suggest that when a patient can communicate; an assessment of their mental capacity should be made urgently, and that if they lack capacity they must be treated in their best interest unless there is an existing living will. In 2004, the National Institute of Clinical Excellence (NICE) published guidance on SH to advise on the short-term physical and psychological management and secondary prevention of SH in primary and secondary care (NICE 2004). The purpose of this paper is to explore the differing staff perceptions in emergency ambulance services in the UK. The factors associated with SH, what motivates a person to SH? This could be multi-agency training to ensure a truly joined up approach. the person should be non-judgemental, non-prejudiced, calm, honest and intelligent. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) provides clinical advice, and produces a set of nationally applicable evidence-based clinical practice guidelines, which are regularly reviewed and updated. These are presented in more detail in Appendix A. But despite this increase, 43% of ED attendances conveyed by ambulance are discharged, with over two-thirds of those discharged not needing follow-up treatment (DOH 2009). • Section 135 (a): an AMHP can seek a warrant from a magistrate, to allow a police officer, the AMHP and a doctor to enter premises and remove a patient to ‘a place of safety’ for assessment. The guidelines provided by JRCALC offer support and advice to paramedics and ambulance services, informed by the best available evidence.  Despite this, organisations such as the College of Paramedics have previously criticised JRCALC for their poor referencing of such evidence (CoP 2008). Such referral pathways for older people who fall have been evaluated through large scale research studies, such as the SAFER studies by Snooks et al (2004, 2012, 2017a, b). Quinlivan et al (2014) also found that mental health staff were less likely to use published risk scales, reflecting a greater reliance on comprehensive psychosocial assessment. Other pieces of equipment employed by a paramedic include spinal and traction splints. The paramedics are usually on standby at a local ambulance station. ment of student paramedics in the clinical environment. As a paramedic, you would provide a high level of care to patients involved in an accident or emergency, such as: 1. victims of a road traffic accident who have multiple or severe injuries 2. a person who has suffered a stroke or heart attack 3. an elderly person who has fallen down the stairs 4. a sick or ill child or young person 5. a very sick baby being moved to a specialist centre 6. a pregnant woman Sometimes you would work independently and use an emergency response car, a motorbike or bicycle to reach the pati… In the United Kingdom, paramedic education has evolved from technician training of approximately 400 hours plus placements, to a Foundation Degree Since staring this study, JRCALC has published three updated sets of guidelines (JRCALC 2004; 2013; 2016). In 2001, the introduction of the Health Professions Order (Health Professions Order 2001) required UK paramedics to register with the regulatory body the Health Professions Council from July 2003. Nice (2004 p.48) also forwards key priorities for implementation, which are provided on more detail in Appendix B, and include the need for respect, understanding and choice, staff training, effective triage, and an assessment of risk. Most paramedics work for the NHS and are recruited and employed in individual NHS trust ambulance services covering specific geographical areas. It set out organisational goals and milestones, for the care of AMI, and many ambulance Trusts responded with strategies which included further development of their extended training into paramedic schemes. These are Red 1 and Red 2 calls where an ambulance is required at the scene within a target time of eight minutes. Most paramedics are field-based, in ambulances. Obviously, the paramedics are directly involved in saving life, giving hope to hopeless situations. Along with legislation and guidance documents on the application of such legislation, there is overarching strategy and policy which has implications for caring for people who SH. It’s a fast-paced and vital role where you’ll need to quickly take charge of the situation to save lives. 9th Dec 2019 After 12 months of experience and satisfactory reviews, the Ambulance Services Proficiency Certificate, also known as the Millar program and certificate (Ministry of Health 1966a, 1966b), was awarded as the basic qualification to ambulance staff. Ambulance services and paramedics feature frequently in the Mental Health Crisis Care Concordat (2014), which also involves a wide range of partners including health and social care, commissioners, the police, and local communities. Typical duties of the job include: driving and staffing ambulances and other emergency vehicles However, some paramedics may perform some roles that are hospital-based, a typical example is treating minor injuries. We present a commentary of recent draft consultations by the National Institute for Health and Care Excellence in England that set out how the role of paramedics may be evolving to assist with the changing demands on the clinical workforce. East Of England Ambulance Trust – January Survey Results! The sections used in emergency detention of SH are summarised below: • Section 4: Is applied in emergency situations to detain a person for up to 72 hours in the interests of their own health and safety or to protect other people. Conclusion Current published research identifies that the role of the paramedic working in primary and urgent care is being advocated and implemented across the UK; however, there is insufficient detail regarding the clinical contribution of paramedics in these clinical settings. The ‘Paramedic Practitioner’ role has developed against a background of change in primary care service provision, apparently resulting in an increasing utilisation of emergency ambulance services. While Stirling et al. Usually, before any other professional healthcare team, paramedics are the first to arrive on accident scenes; they are usually prompt at other forms of medical emergencies. RCPsych (2006) suggest that Ambulance trusts, the ED and mental health trusts should develop locally agreed protocols for alternative care pathways for people who have self-harmed. In terms of SH, the intention of the Mental Health Code of Practice (2015) is to protect patients, and particularly those at risk of suicide and SH. ... www.hcpc-uk.org This document is available in alternative formats and Welsh on request. But we must also recognise that in too many cases people find that the same services do not respond so well. These changes were designed to ensure police officers can act quicker and more flexibly, whilst ensuring that people receive the assessment and treatment they need in a timely manner. This includes making sure there is provision for round-the-clock advice from mental health professionals, within the clinical support infrastructure in each 999 ambulance control room. At the scene of the emergency, they quickly assess patients’ conditions and take action using recommended guidelines and procedures. Quinlivan et al (2014) found that a wide range of invalidated tools were in use among ED’s and mental health services, which, they suggested demonstrates little consensus over the best instruments for risk assessment, and reflects the style of service provision in that setting and a ‘high risk’ approach to management. The vision of the Concordat recognises the role of paramedics in providing initial assessment to people in mental health crisis, whilst acknowledging concerns, and that services do not always respond well, stating: “Every day, people in mental health crisis situations find that our public services are there when they need them – the police officers who respond quickly to protect people and keep them safe; the paramedics who provide initial assessment and care; the mental health nurses and doctors who assess them and arrange for appropriate care; and the Approved Mental Health Professionals, such as social workers, who coordinate assessments and make contact with families.” (p.6), “These services save lives. Guidelines recognise many of these factors, but in order to make meaningful improvements in the care for people who SH, recognising this is not enough. Anyone aspiring to become a paramedic must possess certain characteristics – e.g. The amendments also make clear that a suitable private property (with consent of the occupier) is an appropriate place of safety. In this chapter a discussion is presented acknowledging the move towards clinical effectiveness, governance, and evidence-based care in ambulance services, and its role in the development of United Kingdom (UK) ambulance services and the paramedic profession. They may also try to calm aggressive people in an emergency scene. Figure 2: Age-standardised suicide rates by sex, deaths registered between 1981 and 2015 (ONS 2015). Introduction In the year 1966, important advances in mobile coronary care and trauma care in the UK and USA influenced globally the development of modern prehospital emergency services and paramedic education. Following SH, all patients should have a full bio psychosocial assessment carried out by a skilled and experienced clinician (RCPsych 2010, NICE 2004) which assesses a range of factors such as personal circumstances, social context, mental state, risk and needs, and is central to the clinical management of SH. Important changes around timings of detentions were also introduced through the Police and Crime Act (2017). In that year, to meet the evolving role of prehospital care in the UK, the ‘Millar Report’ specified a new syllabus for ambulance personnel in England. Measuring such capacity requires the patient’s ability to make decisions as well as: • Understanding information relating to the specific decision, • Using the information to make a choice. There have long been concerns about the way in which health services, social care services and police forces work together in response to mental health crises.” (p.6). There was limited information on the psychosocial aspects of SH discussed earlier in this thesis, such as why people SH, what people think of care after SH, and the link between SH and completed suicides. Current prehospital care provision: Within the United Kingdom and internationally. RCPsych (2006) echoes many of the points raised in relation to ambulance staff in NICE (2004) guideline. Assessment, in which the patients’ views are taken seriously, and where they are encouraged to participate in decisions about their care and treatment, and have clear explanations for decisions taken, are highly rated (Taylor et al, 2009). Role of a Paramedic As a healthcare professional, the role of a paramedic is focused in medical emergency situations. In order to get … Since the publication of the NICE (2004) SH guidelines, the role of ambulance staff in the care of people who SH appears frequently in guidelines. The guidelines were intended for use by clinicians, and commissioners of services intent on providing and planning care for those people who SH, while also emphasising the importance of the experience of care for service users and carers. Acknowledging the link between SH and suicide, the UK Government has sought to reduce suicide through strategies involving collaboration between professional groups, and guidance and training for health staff (NICE 2004, NSF Mental Health 1999. In 2014 the UK Department of Health published the Mental Health Crisis Care Concordat: Improving outcomes for people experiencing mental health crisis (Mental Health Crisis Care Concordat 2014). Since this time UK ambulance staff and paramedics have evolved their role, where early ambulance attendants in the UK were once only required to  hold a drivers licence vehicle and offer vocational first aid (Kilner 2004), to today’s greatly expanded range medical care provision by paramedics, supported by national standards in education and training, laid down by a range of organisations, such as the Health & Care Professions Council (HCPC) and professional college, the College of Paramedics (CoP) which are respectively their registered professional body and professional college. In order to improve care in this encounter, it is important to understand SH, what SH is and what it is not, so that subsequent care and treatment is appropriate to the needs of the person. The Police and Crime Act (2017) changes included the definition of public place; by identifying the following places where police cannot exercise their powers under section 136: a) any house, flat or room where that person, or any other person, is living, or; b) any yard, garden, garage or outhouse that is used in connection with the house, flat or room, other than one that is also used in connection with one or more other houses, flats or rooms.’. This general decline in suicide deaths across all ages is shown in Fig 2. The NSF (1999) identified care for those who SH as a key area to meeting a 20% reduction in suicides by 2010, and the National Service Framework on Mental Health (NSF MH 1999) was published to help meet these targets. and wider issues which influence SH, are also important considerations to improving how paramedics respond to people who SH. It is therefore important that care for people who SH is based on good evidence in order to provide clinically and cost effective care. The role of the paramedic has developed over recent years to meet the move towards supporting patients to be treated and managed within their own home. The changes also now allow for a person to be kept at a place of safety (and not solely removed for a mental health assessment if it is appropriate and they consent. Some services employ personnel trained only for driving an emergency vehicle, and may not have medical training of any type. As there have been substantial changes and updates in legislation, policy, case law, and professional practice, this code was revised in 2015 to reflect and embed developments in areas including the use of restrictive interventions, seclusion, use of police powers to detain people in places of safety, and the use of community treatment orders. The Urgent and Emergency Care Review (Keogh 2013) sets out a vision where sustainable, high-quality care in hospitals will be achieved in future by relieving pressure on hospital-based emergency services, thus maximising the chances of survival and recovery for people with more serious or life-threatening emergency needs. The Franco-German model is also utilised in many areas of South America, particularly in Argentina, Chile, Uruguay, and Brazil (Al-Shaqsi 2010). at the end of the 24-hour period an extension of up to 12 hours may be granted by the registered medical practitioner responsible for the examination of the patient. They include the need for rapid assessment of physical and psychological need (triage), effective engagement of service users, effective measures to minimise pain and discomfort, timely initiation of treatment, rapid and supportive psychosocial assessment (including risk assessment and comorbidity), and prompt referral for further psychological, social and psychiatric assessment and treatment when necessary, and an integrated and planned approach to the problems of people who self-harm. The paramedic profession, along with the broader structure and mission of NHS emergency ambulance provision, is undergoing significant but rather undefined change. The role of the paramedic is one that is rapidly evolving, across many countries. Reference this. As a healthcare professional,  the role of a paramedic is focused in medical emergency situations. However, if the patient has capacity and refuses treatment, the patient’s GP should be contacted urgently to fully assess their level of capacity. As a result, new roles for paramedics working in primary and urgent care settings are being developed, either via direct employment or via paramedics on rotation from the ambulance service . It has been estimated that only 10% of patients in the 999 case mix, for example, have a life-threatening condition (DOH 2005). There is a growing academic interest in the examination and exploration of work intensification in a wide range of healthcare settings. In the UK two pieces of legislation are of fundamental importance in SH. Section 136A also permits the secretary of state to make regulations regarding the use of police stations as places of safety, and may in future include provision for regular review and availability of appropriate medical treatment. The recommendations from NICE (2004 p.55) dedicated to ambulance staff are presented in appendix C. They apply many of the general principles in caring for SH set out above. The ambulance technician or emergency care assistant will also help in administering the treatment. The Concordat also provides examples of good practice such as the section 136 working group for Lincolnshire. The decision would usually involve the appropriate treatment to be administered immediately, before taking the patient to the hospital. You can view samples of our professional work here. through National Service Frameworks and a new National Institute for Clinical Excellence (NICE), • Local delivery of high quality health care, through clinical governance underpinned by modernised professional self-regulation and extended lifelong learning. You can join the College of Paramedics and get access to courses, conferences and workshops to keep your skills up to date, and to swap ideas with colleagues in the profession. However, shift duties are also part of the working conditions. If the person lacked mental capacity JRCALC (2006) advised that they must be treated in their best interest unless there is an existing living will. Move towards clinical effectiveness, governance, and evidence-based care in ambulance services: Along with changes to education for ambulance staff, throughout the 1990s and 2000s a move towards clinical effectiveness, governance, and evidence-based care in ambulance services resulted in an evolution of the direction of UK Ambulance Trusts and the paramedic role. The development of the paramedic role The roots of modern paramedics and ambulance services lie in the battlefields of the Crimean war, which saw the formation and organisation of ambulances and medical attendants, dedicated solely to the care of the wounded. The FRV carries a LUCAS, a machine that automates chest compressions in a cardiac arrest patient. The new NHS modernisation programme emphasised the importance of national standards to ensure consistent, high-quality care as specified in a first-class service (NHS Executive 1998), and the health service circular: Modernisation of Ambulance Services (NHS Executive 1999) set out the government’s view that quality care should be at the heart of the National Health Service. As these guidelines have evolved, they increasingly reflect the recognition of the role of paramedics in the care for people who SH. Job opportunities are therefore generally good, but the number of vacancies varies between regions across the UK. Before considering paramedics’ perceptions of caring for people who SH, it is important to recognise the context for the care that is provided by paramedics. 44). The Royal College of Psychiatrists (2010) hold that SH is a behaviour trait, a manifestation of emotional distress, and an indication that something is wrong, rather than a primary disorder. A series of significant events occurred in UK ambulance service provision which supported the development of UK paramedics. Such factors therefore have implications around the assessment of SH as a mental health problem, and application of legislation such as the Mental Capacities Act (2005) and Mental Health Act (1983). They added that if the incident was more critical, and there was insufficient time, crews should act more formally, and in the patients best interest as they currently act rather intuitively, using documentation to assess whether they perceive the patient to be at risk of suicide.  They advocated the use of a suicide assessment form (fig 3) for this, which they advised may be of value in assessing some mental health patients who either lack mental capacity or rationally. NICE (2004) also provide clear guidance to Ambulance Trusts, the ED and Mental Health Trusts on the need to work in partnership to develop locally agreed protocols for ambulance staff to consider alternative care pathways to emergency departments for people who have SH. Those carrying out functions for these parties should understand the policies and their purpose, the roles and responsibilities of other agencies involved, and follow the local policy and receive the necessary training to be able to carry out fully their functions. UK Ambulance Services are increasingly resisting characterisation as either Franco-German or Anglo-American, as a range of medical and allied health professionals now deliver services, and models of care are emerging which include mental health nurses and GPs working together in ambulance control rooms, or joining police, ambulance and mental health triage teams, which are then deployed by ambulance services. The historical context of the development of paramedics is considered, reflecting their origins, which stem from dealing in military conflict, and how this influenced the trajectory of paramedic and ambulance service care, to initially focus on trauma and life threatening emergencies. Free resources to assist you with your university studies! HM Prison Service 3. private ambulance services 4. overseas health departments 5. oil and ga… There needs to be an understanding from the paramedic perspective why people SH? We're here to answer any questions you have about our services. The concordat reinforces how emergency staff should treat people who have self-harmed which is in line with the NICE (2004) guidance. Entry level emergency responders may only have basic CPR training; while more advanced professionals have undergone much more extensive curricular studies. Further information. Choosing the University Route Get 2-3 Advanced levels to enroll at a university. This positions the ambulance service, and paramedics at the centre of care for people not only with life threatening problems, but also those with urgent (non-life threatening) conditions, providing highly responsive, effective, and personalised services outside of the hospital. The Anglo-American model uses non-physician EMS units. The Millar (Ministry of Health 1966a, 1966b) programme evolved into the Institute of Health and Care Development (IHCD) ambulance technician programme (IHCD 2000), which was equivalent to its international counterpart, the Emergency Medical Technician (EMT) programme (Pozner et al 2004). The aim of the Concordat was for collaboration and improved care in a crisis for people with mental health problems, however the concordat resulted in joint statements, written and agreed by signatories, describing what people experiencing a mental health crisis should be able to expect of the public services that respond to their needs. These recommendations are summarised in Appendix D, and again call for Ambulance services to work with other organisations to develop care pathways including service users being taken directly to mental health units, primary care, crisis intervention teams or to social services. The chapter explores how current policies, legislation and guidelines are increasingly reflecting this modern context of paramedic care, and the reader is presented with details of these policies, legislation and guidelines, along with a discussion of their implications for ambulance services and paramedics. In contrast, the Franco-German model relies on physicians, and emphasizes a high degree of on-scene stabilisation prior to transportation to hospital. Paramedics respond immediately to 911 emergency calls involving any type of accident, disaster or medical emergency. Other services require basic levels of certification, and may employ medical certification or licensure at an EMT or nursing level. 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